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Friday, 18 February, 2000, 00:58 GMT
Over-optimistic doctors 'bad for patients'

Doctors prognoses 63% of doctors gave over-optimistic predictions

Most doctors are over-optimistic when asked to predict how long a terminally ill patient will live, a survey shows.

And many patients who are given inaccurate longer survival prospects may suffer in the remaining weeks of their lives.

The findings also show doctors who know their patients personally are a lot more likely to give an over-optimistic prognosis.

Doctors who have had less personal contact, or who are more experienced, are more accurate.

The study, carried out in America and printed in the British Medical Journal, found 63% of predictions were over optimistic, suggesting patients would live five times longer than they actually did. Only 20% were accurate.

'Not surprising'

A British professor said the results were not surprising.

Professor Ilora Finlay, of Holme Tower Marie Curie Cancer Care in Cardiff, told BBC News Online that palliative care was organised differently in Britain and the United States.

Prognoses study findings
468 terminally ill patients studied
Only 20% of prognoses were correct
63% were over-optimistic
17% were unduly pessimistic
Overestimated that patients would live five times longer
Doctors who knew patients personally more likely to overestimate
Doctors who did not know patients more accurate
She said: "The health systems are very different so it is hard to compare.

"In America they have more finance pressures. In Britain we have much more collaborative care between oncologists and palliative specialists.

"However it is very, very difficult to give an accurate prognosis.

"People have to be realistic but it is dangerous to be under pessimistic or under optimistic.

"The survey findings do not surprise me at all and it is good studies are being done into this."

Severe implications

Terminally ill patient Terminally ill patients may not get proper care because of inaccurate diagnoses
Professor Nicholas Christakis and Dr Elizabeth Lamont from the University of Chicago Medical Center say their findings have severe implications.

They say undue optimism about survival rate may contribute to late referral for hospice care and incur unnecessary medical expenses.

They also suggest doctors who do not realise how little time is left for their patient may miss the opportunity of improving the quality of their remaining life.

And Prof Christakis and Dr Lamont also say patients may request futile aggressive care, believing they have longer to live, rather than more beneficial palliative care.

Second opinion

The authors believe clinicians should seek second opinions from experienced doctors who would provide a truer prediction.

Although many doctors are faced with the question "How long have I got to live?" many times a year, the topic is rarely discussed in training or included in medical textbooks, and it makes up less than 4% of published stories.

Physicians were often taught not to make predictions, but to focus on providing hope.

Prof Christakis said: "At some point patients might benefit more from having their doctors focus on the hope for a good death."

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See also:
01 Jul 99 |  Health
Doctors fail with terminal cancer
28 Oct 99 |  Health
Mood swings 'create euthanasia danger'

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